Individual
DR. JAMES M. SHADDOCK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
516 N. BRISBANE AVE, GREELEY, CO 80634
(970) 356-2605
Mailing address
516 N. BRISBANE AVE., GREELEY, CO 80634
(970) 302-7508
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
430
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02043016
—
CO
Enumeration date
04/04/2007
Last updated
04/23/2014
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